I am a primary care physician and researcher, who is committed to understanding and reducing racial/ethnic disparities in cancer. If granted this award, I will build upon my Master's in Public Health degree and my prior research experience to advance my knowledge and skills through coursework, mentored research, apprentice-style learning and semi-structured training. The University of Texas Medical Branch is especially committed to improving the health of the diverse and underserved local populations we serve, through high quality patient care and ongoing research and is very supportive of my career development plan. I have integrated the coursework and research activities so that I can achieve my objectives. The long-term objective of the proposed research is to explain and reduce racial/ethnic disparities in colorectal cancer disease burden. Colorectal cancer is the second leading cause of cancer related deaths in the USA, accounting for ten percent of all cancer deaths. As with other cancers, African Americans carry an unequal burden from this disease, they have the highest incidence and mortality of all racial/ethnic groups. There is now good evidence that screening for colorectal cancer reduces mortality from this disease and currently five screening options are recommended. However, national self-reported screening data suggests that screening levels are poor, especially in minority groups. The higher mortality in African Americans is thought to be due in part to their higher incidence and in part due to their lower screening rates. The research in this plan will address this underutilization of screening about which many unanswered questions remain: there is uncertainty about the accuracy of self-reported screening data, especially in minority patients, and there remains a lack of understanding as to the mechanisms through which race/ethnicity affects screening behavior both for African Americans and Hispanics. In order to address these issues, we plan a series of related aims in a population of African American, Hispanic and Non-Hispanic white patients. We propose a cross-sectional study utilizing a survey instrument that will be developed especially for use in our racial/ethnically diverse population. The purpose of the first aim of our study is to determine the prevalence of age and risk appropriate screening in our patient population. The second aim will determine the accuracy of self-reported information by comparing patient responses to medical record information. The third aim will examine the mechanisms through which a person's race/ethnicity determines their colorectal cancer screening behavior;we will examine how patient factors, health care system factors and patients'interactions with their environment correlate with self-reported screening behavior. The fourth aim will involve describing patient preferences for the array of CRC screening tests and systematically evaluating other influences on CRC screening such as health care delivery systems and physician factors and finally integrating all this information to design an intervention to increase CRC screening in all groups and to submit it for an R01 application prior to the end of the award.